La Flaca Consents

To my patients: this notice describes how health information about you, as a patient of this practice, may be used and disclosed and how you can get access to your health information. This is required by the Privacy Regulations created by the Health Insurance Portability and Accountability Act of 1996.

My commitment is to your privacy.

My practice is dedicated to maintaining the privacy of your health information. I am required by law to maintain the confidentiality of your health information. I realize that these laws are complicated, but I must provide you with the following important information.

Use and Disclosure of Your Health Information in Certain Special Circumstances:

1. To public health authorities and health oversight agencies authorized by the law to collect information.
2. Lawsuits and similar proceedings in response to a court or administrative order.
3. If required to do so by a law enforcement official.
4. When necessary, to reduce or prevent a serious threat to your health or safety or the health or safety of another individual or the public. We will only disclose to a person or organization able to help prevent the threat.
5. If you are the US of foreign military forces (including veterans) and if required by the appropriate authorities.
6. To federal officials for intelligence and national security activities authorized by law.
7. To correctional institutions or law enforcement officials if you are an inmate or under the custody of law enforcement officials.
8. For Workers Compensation and similar programs.

 Your Rights Regarding your health Information

1. Communication. You can request that my practice communicates with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home rather than at work. We will accommodate reasonable requests.
2. You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care options. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or payment to agree to your request. However, if we agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
3. You have the right to inspect and copy the health information that may be used to decide for you, including patient medical records and billing records, but not including psychotherapy notes. You may submit your request in writing.
4. You may ask to have your health care information amended if you believe it is incorrect, incomplete, and as long as the information is kept by or for this practice. To request an amendment, it’s must be made in writing. You must provide a reason supporting your request for amendment.
5. Right to copy of this notice. You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time.
6. Right to file a complaint. If you believe your privacy right has been violated, you may file a complaint with the board of medical examiner or Secretary of the Department of Health and Human Services. You will be penalized for filing a complaint.